Provider Demographics
NPI:1740377563
Name:KARP, BRUCE I (LCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:I
Last Name:KARP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:YISROEL
Other - Middle Name:
Other - Last Name:KARP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:686 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213
Mailing Address - Country:US
Mailing Address - Phone:718-778-0840
Mailing Address - Fax:
Practice Address - Street 1:1220 AVENUE M
Practice Address - Street 2:SUITE 603
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5204
Practice Address - Country:US
Practice Address - Phone:718-778-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0120691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY334889464Medicaid
NY144892OtherVALUEOPTIONSID
NY0025783002OtherGHI PROVIDERID
NY010264901Medicaid
NY144892OtherVALUEOPTIONS ID
NY144892OtherVALUEOPTIONS ID